SpeedyD, what insurance do you have? What is the policy for out of network DME? My last policy (BCBS) had a 40% copay for out of network vs 20% in network. I think using one of the online suppliers penciled out, considering I got my equipment immediately with no hassle or huge markups. You might want to have a talk with your insurer, and make sure you know their DME policy for in-network, out of network and what their policy is on rental vs purchase. If you get 100% coverage, then it might be worth this hassle, but otherwise, I'd be looking at alternatives.

DMEs are a crap shoot. After my sleep study I saw my doc (just my internist not a sleep doc) and got a copy of my study and a scrip (I told him I wanted APAP ,and mask of choice, he said no problem). I awent around to a couple of local DME supliers and saw that they were at best incompetent and uninterested. I did my research on this board and ordered the equipment I wanted from one of the suppliers listed at the top of the forum. All came promptly and I was off to the races.

ONE MONTH later the sleep center called and said they were ready to see me. Even though my study showed an AHI of 70, it was apparently not much of an urgent situation.

(11-26-2015 11:36 AM)Snowbird47 Wrote: DMEs are a crap shoot. After my sleep study I saw my doc (just my internist not a sleep doc) and got a copy of my study and a scrip (I told him I wanted APAP ,and mask of choice, he said no problem). I awent around to a couple of local DME supliers and saw that they were at best incompetent and uninterested. I did my research on this board and ordered the equipment I wanted from one of the suppliers listed at the top of the forum. All came promptly and I was off to the races.

ONE MONTH later the sleep center called and said they were ready to see me. Even though my study showed an AHI of 70, it was apparently not much of an urgent situation.

Bottom line, take charge of your own treatment.

Uninterested, unmotivated, all this describes DME. They have no idea what we are dealing with.
My AHI is 94. No hurries.

(11-26-2015 10:50 AM)Sleeprider Wrote: SpeedyD, what insurance do you have? What is the policy for out of network DME? My last policy (BCBS) had a 40% copay for out of network vs 20% in network. I think using one of the online suppliers penciled out, considering I got my equipment immediately with no hassle or huge markups. You might want to have a talk with your insurer, and make sure you know their DME policy for in-network, out of network and what their policy is on rental vs purchase. If you get 100% coverage, then it might be worth this hassle, but otherwise, I'd be looking at alternatives.

I am med mutual. I have called insurance many times. They just said it is 85-15%. Nothing about in or out of network.. Sigh. I'm taking a nap now so I can properly finish cooking Thanksgiving dinner.

Enjoy the nap. When business hours are back in session, ask the insurer how they would reimburse out of network DME and how to file a claim. I suspect it's a 30% share for you, in which case, you'd save a lot just doing it. You have a prescription, right? If you can afford to wait for insurance reimbursement, it's really the best. Seriously, online DMEs charge less than $900 for a top of the line APAP complete with heated hose and all the rest. Lincare will charge you $1800 for any CPAP, try to give you a cheaper one, and will charge you separately for the humidifier and heated hose. Your copay will be higher.

(11-26-2015 01:48 PM)Sleeprider Wrote: Enjoy the nap. When business hours are back in session, ask the insurer how they would reimburse out of network DME and how to file a claim. I suspect it's a 30% share for you, in which case, you'd save a lot just doing it. You have a prescription, right? If you can afford to wait for insurance reimbursement, it's really the best. Seriously, online DMEs charge less than $900 for a top of the line APAP complete with heated hose and all the rest. Lincare will charge you $1800 for any CPAP, try to give you a cheaper one, and will charge you separately for the humidifier and heated hose. Your copay will be higher.

I fought so hard to get the right machine ordered and I'm still gonna get hosed!!! Arghh!
This is causing me anxiety. I will be making a personal visit tonlincare office tomorrow!

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